Innovations in Radiotherapy in the Treatment of Prostate Cancer: Improving Results And Minimizing Side Effects

Beybalaeva A. T.
Assistant, Chair for Internal Medicine, Pediatric and Dental Faculties¹

Isupanova K. M.
Student, Medical Faculty²

Kastoeva A. A.
Student, Medical Faculty³

Magomedov C. G.
Student, Medical Faculty⁴

Saidova F. H.
Student, Medical Faculty⁵

Khagazheeva A. K.
Student, Medical Faculty⁶

Kutueva M. I.
Student, Medical Faculty⁶

Tagirova M. M.
Student, Medical Faculty⁶

Khabalaeva Y. R.
Student, Medical Faculty⁶

Shatilova T. A.
Student, Medical Faculty⁶

Kardanova Z. A.
Student, Medical Faculty⁷

1 - Dagestani State Medical University, Makhachkala, Republic of Dagestan, Russian Federation
2 - Kabardino-Balkarian State University, Nalchik, Republic of Kabardino-Balkariya, Russian Federation
3 - Ingush State University, Magas, Republic of Ingushetiya, Russian Federation
4 - Saratov State Medical University, Saratov, Russian Federation
5 - Chechen State University, Grozny, Republic of Chechnya, Russian Federation
6 - North Ossetian State Medical Academy, Vladikavkaz, Republic of North Ossetiya-Alaniya, Russian Federation
7 - Stavropol State Medical University, Stavropol, Russian Federation

Beybalaeva Albina; e-mail: beybalaeva89@mail.ru.

None declared.

The study had no sponsorship.

Prostate cancer is one of the most common oncological diseases affecting men and causing an increase in the mortality rate among men worldwide. Russia has also seen a significant increase in morbidity and mortality in recent years. Currently, there is no absolutely effective method of treating prostate cancer. It is necessary to search for new economically justified methods with minor side effects or without them. The purpose of this article is to compare the methods of radiation therapy, to determine the advantages of innovative methods improving results and minimizing side effects in the treatment of patients with prostate cancer. We reviewed the current state of remote radiotherapy (EBRT/DLT) in high-risk cases, including the use of androgen deprivation therapy (ADT/ADT), the role of hypofractionation and stereotactic radiotherapy (SBRT/STLT), new data on combination therapy. An analysis of publications has shown the feasibility of combining long-term ADT and remote radiotherapy in patients with high-risk prostate cancer for maximum disease control and increased overall survival compared with treatment without this combination. Randomized data suggest that increasing the dose with LDR brachytherapy may be more effective than increasing the dose with EBRT alone. Over the past decade, advances in technology, imaging capabilities, and improved radiobiological understanding have profoundly changed radiation therapy for prostate cancer, allowing for increased dose and widespread introduction of hypofractionation. In addition, the integration of magnetic resonance imaging (MRI) and improved physical accuracy of dose delivery gave impetus to additional targeting of intra-static tumor lesions previously independent of the traditional concept of determining the target of radiation therapy.

prostate cancer, radiation therapy, low dose rate brachytherapy (LDR/HMBT), high dose rate brachytherapy (HDR/HMBT), androgen deprivation therapy (ADT/ADT), hypofractionation, stereotactic radiation therapy (SBRT/STLT), intensity modulated radiation therapy (IMRT/LTMI)

10.29234/2308-9113-2023-11-2-84-99

1. Abdollah F., Karnes R.J., Suardi N., et al. Impact of adjuvant radiotherapy on survival of patients with node-positive prostate cancer. Journal of Clinical Oncology 2014; 32(35): 3939-3947.

2. Zelefsky M.J., Reuter V.E., Fuks Z., Scardino P., Shippy A. Influence of local tumor control on distant metastases and cancer related mortality after external beam radiotherapy for prostate cancer. Journal of Urology 2008; 179(4): 1368-1373.

3. Aluwini S., Pos F., Schimmel E. et al. Hypofractionated versus conventionally fractionated radiotherapy for patients with prostate cancer (HYPRO): acute toxicity results from a randomised non-inferiority phase 3 trial. The Lancet Oncology, 2016; 16(3): 274-283.

4. Zelefsky M.J., Reuter V.E., Fuks Z., Scardino P., Shippy A. Influence of local tumor control on distant metastases and cancer related mortality after external beam radiotherapy for prostate cancer. Journal of Urology 2008; 179(4): 1368-1373.

5. Amini A., Jones B.L., Yeh N., Rusthoven C.G., Armstrong H., Kavanagh B.D. Survival outcomes of whole-pelvic versus prostate-only radiation therapy for high-risk prostate cancer patients with use of the national cancer data base. International Journal of Radiation Oncology, Biology, Physics 2015; 93(5): 1052-1063.

6. Rusthoven C., Carlson J.A., Waxweiler T.V., et al. The impact of definitive local therapy for lymph node-positive prostate cancer: a population-based study. International Journal of Radiation Oncology, Biology, Physics 2014; 88(5): 1064-1073.

7. Widmark A., Klepp O., Solberg A., et al. Endocrine treatment, with or without radiotherapy, in locally advanced prostate cancer (SPCG-7/SFUO-3): an open randomized phase III trial. The Lancet 2009; 373(9660): 301-308.

8. Wilkins A., Mossop H., Syndikus I., et al., Hypofractionated radiotherapy versus conventionally fractionated radiotherapy for patients with intermediate-risk localized prostate cancer: 2-year patient-reported outcomes of the randomized, noninferiority, phase 3 CHHiP trial The Lancet Oncology 2015; 16(16): 1605-1616.

9. Warde P., Mason M., Ding K., et al., Combined androgen deprivation therapy and radiation therapy for locally advanced prostate cancer: a randomized, phase 3 trial. The Lancet, 2011; 378(9809): 2104-2111.

10. Bossi A., Blanchard P., Hypofractionation for prostate cancer: a word of caution. The Lancet Oncology 2016; 17(4): 406-407.

11. Lawton C. A., DeSilvio M., Roach III M., et al. An update of the phase III trial comparing whole pelvic to prostate only radiotherapy and neoadjuvant to adjuvant total androgen suppression: updated analysis of RTOG 94-13, with emphasis on unexpected hormone/radiation interactions. International Journal of Radiation Oncology, Biology, Physics 2007; 69(3): 646-655.

12. Aluwini S., Pos F., Schimmel E., et al. Hypofractionated versus conventionally fractionated radiotherapy for patients with prostate cancer (HYPRO): acute toxicity results from a randomised non-inferiority phase 3 trial. The Lancet Oncology 2016; 16(3): 274-283.

13. Wilkins A., Mossop H., Syndikus I., et al. Hypofractionated radiotherapy versus conventionally fractionated radiotherapy for patients with intermediate-risk localised prostate cancer: 2-year patient-reported outcomes of the randomised, noninferiority, phase 3 CHHiP trial. The Lancet Oncology 2015; 16(16): 1605-1616.

14. Morris W.J., Tyldesley S., Pai H.H. et al., ASCENDE-RT^∗: a multicenter, randomized trial of dose-escalated external beam radiation therapy (EBRT-B) versus low-dose-rate brachytherapy (LDR-B) for men with unfavorable-risk localized prostate cancer. Journal of Clinical Oncology 2015; 33, supp. 7, abst. 3.

15. Kotecha R., Djemil T., Tendulkar R.D., et al. Dose-escalated stereotactic body radiation therapy for patients with intermediate and high-risk prostate cancer: initial dosimetry analysis and patient outcomes. International Journal of Radiation Oncology, Biology, Physics 2016; 95(3): 960-964.

16. Aluwini S., van Rooij P., Hoogeman M., Kirkels W., Kolkman-Deurloo I.-K., Bangma C. Stereotactic body radiotherapy with a focal boost to the MRI-visible tumor as monotherapy for low- and intermediate-risk prostate cancer: early results. Radiation Oncology 2013; 8: 84.

17. Bauman G., Ferguson M., Lock M., et al. A phase 1/2 trial of brief androgen suppression and stereotactic radiation therapy (FASTR) for high-risk prostate cancer. International Journal of Radiation Oncology, Biology, Physics 2015; 92(4): 856-862.

18. King C.R., Freeman D., Kaplan I., et al. Stereotactic body radiotherapy for localized prostate cancer: pooled analysis from a multi-institutional consortium of prospective phase II trials. Radiotherapy and Oncology 2013; 109(2): 217-221.

19. Mason M.D., Parulekar W.R., Sydes M.R., et al. Final report of the intergroup randomized study of combined androgen-deprivation therapy plus radiotherapy versus androgen-deprivation therapy alone in locally advanced prostate cancer. Journal of Clinical Oncology 2015; 33(19): 2143-2150.

20. Studer U.E., Whelan P., Albrecht W., et al. Immediate or deferred androgen deprivation for patients with prostate cancer not suitable for local treatment with curative intent: European organisation for research and treatment of cancer (EORTC) trial 30891. Journal of Clinical Oncology 2006; 24(12): 1868-1876.

21. Kuban D.A., Tucker S.L., Dong L., et al. Long-term results of the M. D. Anderson randomized dose-escalation trial for prostate cancer. International Journal of Radiation Oncology, Biology, Physics 2008; 70(1): 67-74.

22. Arcangeli S., Strigari L., Gomellini S., et al. Updated results and patterns of failure in a randomized hypofractionation trial for high-risk prostate cancer. International Journal of Radiation Oncology, Biology, Physics, 2012; 84(5): 1172-1178.